Provider Demographics
NPI:1215919188
Name:CHRISTEN, ROBERT N II
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:CHRISTEN
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 WELLS ST
Mailing Address - Street 2:
Mailing Address - City:SISTERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26175-1324
Mailing Address - Country:US
Mailing Address - Phone:304-652-2459
Mailing Address - Fax:304-652-1551
Practice Address - Street 1:624 WELLS ST
Practice Address - Street 2:
Practice Address - City:SISTERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26175-1324
Practice Address - Country:US
Practice Address - Phone:304-652-2459
Practice Address - Fax:304-652-1551
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5378152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2409932Medicaid
WV3101043000Medicaid
OHU96227Medicare UPIN
OH2409932Medicaid
WV9387281Medicare PIN
OH4950560001Medicare NSC
OH4113181Medicare PIN